Tailbone Book, Chapter 7: Tailbone Fracture. Broken Coccyx.

Tailbone Book, Chapter 7: Tailbone Fracture. Broken Coccyx.

This is the next in a series of coccyx pain videos, giving you highlights from the chapters of Dr. Foye’s book, “Tailbone Pain Relief Now!”

The actual VIDEO is at the bottom of this page.

Here is the TEXT from the video:

Hi, I’m Dr. Patrick Foye. I’m an M.D. or Medical Doctor and I’m the Director of the Coccyx Pain Center, or Tailbone Pain Center, here in the United States. I’m online at www.TailboneDoctor.com.

And this is the next in the series of videos going chapter by chapter through my book “Tailbone Pain Relief Now!”

And in this chapter, we are up to chapter number 7, which is Tailbone Fractures: The Broken Coccyx. And this is a really important chapter because: fractures of the tailbone, number 1, they can be very painful and they can take a very long time to heal; and number 2 is that it is probably the most over-diagnosed and misdiagnosed condition at the tailbone.

It is very very common that people will have some trauma, they slip and fall, they land on their buttocks. They land on their coccyx or tailbone. And then they have some pain. And maybe they go to see their primary care doctor or a musculoskeletal specialist or they even go to the emergency room.

And the doctor will say, “Well, you know what? You fractured your tailbone.” Sometimes without even getting an x-ray. Or, they will get the wrong x-ray. It will be of the lumbar spine or they won’t do the proper imaging to properly show the tailbone. But they will be told, “You know what? You probably fractured your tailbone.”

And it is important because you really want to have an accurate diagnosis so that you can develop a treatment plan based on an accurate diagnosis rather than just somebody saying off the top of their head, “Maybe it’s fractured.”

The way I would think about this and the way I describe it to patients is as follows: If you think about the bones of the coccyx, really they are… this is the sacrum up here and then the coccyx or tailbone is shown right down here. And from the side view it looks sort of like that.

So the coccyx is really a series of bones. You can see that there’s a number of bony segments here. And sometimes parts of them are fused together and sometimes not. And the reason that is important in this chapter and this discussion about fractures is that sometimes an emergency room physician or maybe even a radiologist will look and see that there’s discrete individual segments at the tailbone as shown here. And they will think, “Oh well, you know what? Maybe that section down at the bottom is fractured off. I see a space, I see a lucency, a clear area where there’s no bone there.”

And the reason why that can be misleading is because there is supposed to be a clear space between the bones if the bones are not fused together. Just like if you took an x-ray of my fingers, you would have a bone here and then you would have a clear space where the joint is, and then you would have the next bone and a space, and then the next bone and a space. So where the knuckles are, there would be a joint space in those areas.

And the same is true at the tailbone. But unfortunately, many many times the emergency room doctor or the radiologist will somehow forget the basics that they know anywhere else in the body. And when it comes to the tailbone, they will see that lucency and they will call it as a fracture. They will see that lucency and they will say, “Yes, there’s a chip of the bone that came off”, when really it is just the normal joint space that we expect to be there in most of us (in all of us that do not have a “fused” coccyx).

So, what is a fracture then? Well, a fracture is when you actually have broken the bone. And the easiest way to think about this is, I describe it as if you think about a stack of bricks, if you were stacking bricks one on top of the other, the tall way, that would be a little bit similar to the bones in the coccyx stacked one on top of the other here.

And you would expect there to be a joint space, a little bit of space in between those bricks, a little sliver of air in between brick number 1 and brick number 2 and brick number 3, etc. And when you see that little bit of joint space, that is NOT a fracture. The brick, each individual brick, if it is still intact then there is NO fracture.

So similarly for the coccyx, if each individual bone of the coccyx is intact, there is NO fracture. Now what people may have is they may have a DISLOCATION, they may have where one bone has moved away from the other, but that is NOT a fracture. Back to our brick example, that would be two bricks that are moved apart but they are still intact, each individual brick is not chipped or broken.

So that’s a real distinguishing factor between a dislocation and a fracture. And there is another chapter where we will talk more about dislocations.

So then, what is a fracture? Again, a fracture is when piece of the bone is actually broken; so as shown here, that can happen in a number of different ways. In this top bone here we have basically what is called a “hairline fracture”, which is you can see the fracture line sort of going through the bone here, but the pieces of the bone are still essentially together. So that’s a hairline fracture.

And what is more severe is what is called the “displaced fracture”, which is here where a piece of the bone has actually separated from the rest of the bone. So, the difference between a hairline fracture, also called a non-displaced fracture and a displaced fracture is whether one piece of a given bone has actually separated from the other piece of that same bone that it was normally attached to. So that’s a non-displaced fracture versus a displaced fracture.

Another term you will sometimes hear is a “comminuted fracture”, which just basically means that unfortunately the bone is shattered so it is broken up into many many pieces. So think about dropping a teacup and it shatters into many pieces that would be equivalent to a comminuted fracture.

So there are again different types of fractures. And in the chapter we go into the fact that to make a diagnosis of a fracture you really need imaging studies; so just knowing that somebody is tender there or that they have some bruising or that they had some trauma, that alone is not enough to officially make a diagnosis of a fracture. You really need to have the imaging studies to see what is going on with the bones and are the individual bones intact or not.

So, to do that you have to have the proper imaging studies done and unfortunately, it is very very common that the proper imaging studies either are… no imaging are done at all, or the proper imaging studies are not performed. So the ordering physician and the radiology technician and the radiologist need to have some insight or experience in evaluating tailbone pain and tailbone problems and tailbone injuries in order to do the proper tests.

The treatment for a fracture really depends on how severe the pain is and there are medications, and the book goes into more of the details, but there are medications that can be used to help to relieve the pain. But a couple of things that I will point out is that treating a fracture at the tailbone is very different than treating a fracture in most other parts of the body.

Because if I had a fracture in my arm, what we could do is we could put my arm in a cast. But you can’t put your tailbone in a cast. For my arm we could put rods and screws in place to hold the fracture stable. But really that’s not so easy at the tailbone. The tailbone are these little tiny bony segments and putting rods and screws through them off the tailbone bones themselves would probably crumble to some extent, so it is really challenging.

Also, you don’t want to just fuse it with rods and screws because then you would be sitting on rods and screws which would be painful and also there is supposed to be some mobility or movement at the tailbone, so if you were to fuse it with orthopedic hardware, you would lose the normal mobility that you need and then the tailbone would be in the way, every time that you go to sit down it would fail to move out of the way. It would fail to move as normal.

So also you can do non-weight-bearing in other parts of the body, like if I had a fracture in my leg we could use crutches so I don’t put any weight on that leg. But at the tailbone that is not so easy. At the tailbone you are basically saying, well do not sit, because that is the weight-bearing position.

But it is very very difficult in modern society to go through the day without sitting; you need to sit to drive in your car or to commute or while you are on your computer workstation to some extent. And some of that we can work around, but still we can stand more, but it is very very difficult to stand through the entire day.

So, very very challenging in some ways in terms of treating fractures at the coccyx. There certainly are treatments that can be done. Later in the book we will get into the chapters about treatment, but there are medications, there are injections, there are other things that are available that do provide relief for the majority of patients.

So there is more information in the book, if you are interested in getting a copy of the book, the easiest way to do that is to go to www.TailboneBook.com. And from there I will have the links to specifically to the direct Amazon pages for your specific country whether you are in the United States or Canada or Europe, U.K., etc. I have those listed on there.

So that is the easiest way to go to get the book. The book is available both as a paperback copy and also as an e-book, so you can get the e-book copy which you can basically download and read that anyplace in the world where you have internet access. You can get that book that way.

If you are looking to find me online, the best way to find me is to just go to my website which is www.TailboneDoctor.com and you can find me there.

Post your comments down below. If you have questions about fractures at the tailbone. If you have been told you had a fracture but they never did an x-ray or imaging study to actually confirm it. Or you had a fracture but you found out later it was never fractured in the first place. Or you were told that it wasn’t fractured and finally they got the imaging and found out that it was. Post your comments and thoughts and questions down below and we will be on the lookout to respond to those.